Hospital-acquired pneumonia in ICU

Marc Leone (1, 2) , Lila Bouadma (3) , Belaïd Bouhemad (4) , Olivier Brissaud (5) , Stephane Dauger (6) , Sébastien Gibot (7) , Sami Hraiech (8) , Boris Jung (9, 10) , Eric Kipnis (11) , Yoann Launey (12) , Charles-Edouard Luyt (13) , Dimitri Margetis (14) , Fabrice Michel (15) , Djamel Mokart (16) , Philippe Montravers (17) , Antoine Monsel (18) , Saad Nseir (11) , Jérôme Pugin (19) , Antoine Roquilly (20) , Lionel Velly (15) , Jean-Ralph Zahar (21, 22) , Rémi Bruyère (23) , Gérald Chanques (9)

1 URMITE - Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
2 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
3 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
4 Service de neuroradiologie, imagerie des urgences [CHU de Dijon]
5 CHU de Bordeaux Pellegrin [Bordeaux]
6 AP-HP Hôpital universitaire Robert-Debré [Paris]
7 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
8 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
9 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
10 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
11 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
12 CHU Pontchaillou [Rennes]
13 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
14 CHU Saint-Antoine [AP-HP]
15 Service d'anesthésie et de réanimation [Hôpital de la Timone - APHM]
16 Institut Paoli-Calmettes
17 Service d'anesthésie - réanimation chirurgicale [CHU Bichat]
18 I3 - Immunologie - Immunopathologie - Immunothérapie
19 HUG - Hôpital Universitaire de Genève = University Hospitals of Geneva
20 CHU Nantes - Centre hospitalier universitaire de Nantes
21 CHU Necker - Enfants Malades [AP-HP]
22 Hôpital Avicenne [AP-HP]
23 Centre Hospitalier de Bourg en Bresse

The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.

Keywords: Monotherapy; Pneumonia; The antibiotic ...

Domains: Life Sciences [q-bio]; Human health and pathology; Infectious diseases

Marc Leone, Lila Bouadma, Belaïd Bouhemad, Olivier Brissaud, Stephane Dauger, et al.. Hospital-acquired pneumonia in ICU. Anaesthesia Critical Care & Pain Medicine, 2018, 37 (1), pp.83-98. ⟨10.1016/j.accpm.2017.11.006⟩. ⟨hal-01788072⟩